Helicobacter pylori infection, plasma ammonia levels, and psychometric testing in cirrhotic patients

OBJECTIVE: The role of Helicobacter pylori (H. pylori) infection as a cause of hepatic encephalopathy is still debated. This study focused on the rela tionship between H. pylori, plasma ammonia levels, and intellectual functio n in cirrhotic patients. METHODS: Forty-seven cirrhotics with latent or mild hepatic encephalopathy were enrolled in the study, upon H. pylori assessment at endoscopy. Plasma ammonia level determinations and psychometric testing were performed at ent ry in all patients. Patients with H. pylori infection received a 2-wk stand ard dual therapy and bacterial eradication was assessed at endoscopy 6-8 wk later. On this occasion, plasma ammonia levels and psychometric assessment s were repeated. Patients without H. pylori infection at entry were also st udied after 6-8 wk for ammonia level assessment and psychometric testing, a s a control group. Patients receiving lactulose therapy and those without t herapy were grouped separately for statistical analysis. RESULTS: Among 21 patients without lactulose therapy (group A), basal plasm a ammonia levels and psychometric testing scores did not significantly diff er between 13 infected and eight uninfected patients. Similarly, among 26 p atients undergoing lactulose therapy (group B), basal plasma ammonia concen tration and psychometric testing scores did not significantly differ betwee n 13 infected and 13 uninfected patients. Moreover, in group B, both the pr evalence of previous overt hepatic encephalopathy episodes and the mean dai ly dose of lactulose therapy were similar between infected and uninfected p atients. In addition, no significant reduction in the plasma ammonia concen trations and in psychometric testing scores emerged in both groups A and B after bacterial eradication. CONCLUSIONS: This study failed to find a relationship between H. pylori, pl asma ammonia levels, and psychometric testing scores in cirrhotic patients with latent or mild hepatic encephalopathy. (Am J Gastroenterol 1999;94:221 4-2218. (C) 1999 by Am. Cell. of Gastroenterology).